The Compliance and Business Integrity (CBI) Officer manages the planning, development, and implementation of compliance initiatives within the Medical Center and CBOCs. The Compliance Officer will function as an independent and objective person who reviews and evaluates compliance issues and concerns (as delineated under Major Duties and Responsibilities below) within the organization with limited guidance from the VACO CBI Program Office, the VISN CBI Officer and facility Director.

Duties

MAJOR DUTIES AND RESPONSIBILITIES: 1) Policies and Procedures Develop written compliance policies and procedures consistent with those established by VHA and Federal Laws that reflect industry standards and practice. Conduct ongoing studies of policies and procedures, resource utilization, and organizational structure for the revenue cycle as related to compliance issues and adapt, modify and change these as needed to conform to compliance standards. Continually review new and revised guidelines, set priorities based on this information, and develop organization-wide initiatives to effectively comply with all current and anticipated requirements. 2) Governance/Structure Promotes ethics standards in cooperation with Regional Counsel, OIG, and the local-designated ethics officer. Produces timely and accurate reports to the Director, Associate Director, VACO, the VISN CBI Officer, and other appropriate personnel and services accompanied by any necessary performance improvement recommendations. Develops and implements a CBI assessment process that will be used internally to determine efficiency and effectiveness of the CBI program as related to business operational areas. 3) Training and Education Responsible for creation of a written training and education plan to include organizational leadership and the members of the Compliance Council, Committee or Board as well as all employees. Coordinate and host an annual compliance and ethics fair each FY. 4) Monitoring/Auditing Reviews internal controls within any related business unit and makes determination as to the unit's adequacy in preventing revenue cycle and Purchased Care operational failures. Develops and implements evaluation and measurement tools, utilizing a variety of software applications, which may include but is not limited to Excel, Access, VSSC, ProClarity, ICB, FBCS, QuadraMed, CRTS, and RAT-STATS. Develops and conducts management surveys and projects to advise the organization about compliance issues that substantially impact the facility. 5) Risk Assessment Serves as the single resource person for providing leadership in all aspects of CBI Risk Assessment and Management processes. Formalize measurement tools for high-risk areas and key indicators of success that have impact on Purchased Care, authorized and non-authorized care, medical care provided under Mill Bill, ChampVA, TriCare, consolidated business operations, billing, coding accuracy, and documentation. Develops guidance, policies, or procedures to address identified risks for all areas facility-wide. 6) Investigation/Response Ensure processes and procedures for formal and informal investigations in accordance with applicable handbooks, directives, Human Resources and guidance from Regional Counsel. 7) Enforcement/Discipline Demonstrate adherence to prohibition of employment of individuals contained on any of the Government Sanctions List (GSL). Recommend training and/or discipline for employees in violation of compliance standards pursuant to the Compliance Plan in conjunction with Human Resources. Other Duties as assigned to include these: Performs a variety of special duties requiring a high degree of managerial and analytical expertise at the request of the Director (e.g., Part-Time Physician Audits to be in compliance with OIG requirements). Work Schedule: Monday - Friday8:00am - 4:30pm Telework: Ad-hoc. VA supports the use of telework as a way to help attract and retain talented individuals in public service, increase worker productivity, and better prepare the agency to operate during emergencies. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. Virtual: This is not a virtual position. Position Description/PD#: Health System Specialist (Compliance and Business Integrity Officer) / PD250580 Relocation/Recruitment Incentives: Not Authorized Critical Skills Incentive (CSI): Not Approved Permanent Change of Station (PCS): Not Authorized

Requirements

Qualifications

To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 01/13/2025. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-12 position you must have served 52 weeks at the GS-11. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: Individual Occupational Requirements Undergrad and Graduate Education: Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. Special Provision for Inservice Placement: Successful completion of an agency-sponsored on-the-job training program may be substituted for qualifying experience, provided it included a formal individualized training plan. Such a training program must have been conducted in an operating health care system and included: Assignments providing a knowledge of basic health system administration philosophies, practices, and procedures, and basic government administrative policies and requirements; Practical assignments providing an opportunity to apply health system administration skills and principles (as the individual progresses, work assignments must be characteristic of the grade level to which he or she is assigned); and Oversight by an experienced health system administrator with periodic evaluation of the individual's progress and appropriate adjustment of the training program. Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-11 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems. Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. You will be rated on the following Competencies for this position: ComplianceInternal ControlsInternal Controls/Integrity Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Physical Requirements: There are no unusual physical demands. The work is performed in an office setting. Travel to the VISN and various internal and external meetings or training is required. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

Education

There is no educational substitution at this grade level.

A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address Beckley VA Medical Center 200 Veterans Avenue Beckley, WV 25801 US
• Name: Melonese Martin
• Phone: 210-996-7135
• Email: [email protected]